Impact of Large Language Model Assistance on Patients Reading Clinical Notes: A Mixed-Methods Study

Patients derive numerous benefits from reading their clinical notes, including an increased sense of control over their health and improved understanding of their care plan. However, complex medical concepts and jargon within clinical notes hinder patient comprehension and may lead to anxiety. We developed a patient-facing tool to make clinical notes more readable, leveraging large language models (LLMs) to simplify, extract information from, and add context to notes. We prompt engineered GPT-4 to perform these augmentation tasks on real clinical notes donated by breast cancer survivors and synthetic notes generated by a clinician, a total of 12 notes with 3868 words. In June 2023, 200 female-identifying US-based participants were randomly assigned three clinical notes with varying levels of augmentations using our tool. Participants answered questions about each note, evaluating their understanding of follow-up actions and self-reported confidence. We found that augmentations were associated with a significant increase in action understanding score (0.63 $\pm$ 0.04 for select augmentations, compared to 0.54 $\pm$ 0.02 for the control) with p=0.002. In-depth interviews of self-identifying breast cancer patients (N=7) were also conducted via video conferencing. Augmentations, especially definitions, elicited positive responses among the seven participants, with some concerns about relying on LLMs. Augmentations were evaluated for errors by clinicians, and we found misleading errors occur, with errors more common in real donated notes than synthetic notes, illustrating the importance of carefully written clinical notes. Augmentations improve some but not all readability metrics. This work demonstrates the potential of LLMs to improve patients' experience with clinical notes at a lower burden to clinicians. However, having a human in the loop is important to correct potential model errors

Performing Automatic Identification and Staging of Urothelial Carcinoma in Bladder Cancer Patients Using a Hybrid Deep-Machine Learning Approach

Simple Summary Early and accurate bladder cancer staging is important as it determines the mode of initial treatment. Non-muscle invasive bladder cancer (NMIBC) can be treated with transurethral resection whereas muscle invasive bladder cancer (MIBC) requires neoadjuvant chemotherapy with subsequent cystectomy as indicated. Our hybrid machine/deep learning model demonstrates improved accuracy of bladder cancer staging by CECT using a hybrid machine/deep learning model which will facilitate appropriate clinical management of the patients with bladder cancer, ultimately improving patient outcome. Abstract Accurate clinical staging of bladder cancer aids in optimizing the process of clinical decision-making, thereby tailoring the effective treatment and management of patients. While several radiomics approaches have been developed to facilitate the process of clinical diagnosis and staging of bladder cancer using grayscale computed tomography (CT) scans, the performances of these models have been low, with little validation and no clear consensus on specific imaging signatures. We propose a hybrid framework comprising pre-trained deep neural networks for feature extraction, in combination with statistical machine learning techniques for classification, which is capable of performing the following classification tasks: (1) bladder cancer tissue vs. normal tissue, (2) muscle-invasive bladder cancer (MIBC) vs. non-muscle-invasive bladder cancer (NMIBC), and (3) post-treatment changes (PTC) vs. MIBC

Intravenous Immunoglobulin-Induced Pulmonary Embolism: It Is Time to Act!

Pulmonary embolism (PE) is a common clinical problem affecting 600,000 patients per year in the United States. Although the diagnosis can be easily confirmed by imaging techniques, such as computed tomographic angiography of the chest, the identification of underlying mechanism leading to PE is important for appropriate duration of anticoagulation, and prevention of subsequent episodes. The differential diagnosis of underlying mechanism is broad and must include careful review of medication history. Drug-related thromboembolic disease can be easily missed and may have catastrophic consequences. The identification of the culprit drug is important for prevention of subsequent episodes and choosing appropriate duration of anticoagulation. We report a case of a middle-aged man who developed PE after administration of intravenous immunoglobulin.12 Month EmbargoThis item from the UA Faculty Publications collection is made available by the University of Arizona with support from the University of Arizona Libraries. If you have questions, please contact us at [email protected]

Top 100 cited articles in cardiovascular magnetic resonance: a bibliometric analysis

Background: With limited health care resources, bibliometric studies can help guide researchers and research funding agencies towards areas where reallocation or increase in research activity is warranted. Bibliometric analyses have been published in many specialties and sub-specialties but our literature search did not reveal a bibliometric analysis on Cardiovascular Magnetic Resonance (CMR). The main objective of the study was to identify the trends of the top 100 cited articles on CMR research. Methods: Web of Science (WOS) search was used to create a database of all English language scientific journals. This search was then cross-referenced with a similar search term query of Scopus® to identify articles that may have been missed on the initial search. Articles were ranked by citation count and screened by two independent reviewers. Results: Citations for the top 100 articles ranged from 178 to 1925 with a median of 319.5. Only 17 articles were cited more than 500 times, and the vast majority (n = 72) were cited between 200–499 times. More than half of the articles (n = 52) were from the United States of America, and more than one quarter (n = 21) from the United Kingdom. More than four fifth (n = 86) of the articles were published between the time period 2000–2014 with only 1 article published before 1990. Circulation and Journal of the American College of Cardiology made up more than half (n = 62) of the list. We found 10 authors who had greater than 5 publications in the list. Conclusion: Our study provides an insight on the characteristics and quality of the most highly cited CMR literature, and a list of the most influential references related to CMR.Medicine, Faculty ofNon UBCRadiology, Department ofReviewedFacult

A systematic review and meta-analysis of the efficacy and safety of the interleukin (IL)-12/23 and IL-17 inhibitors ustekinumab, secukinumab, ixekizumab, brodalumab, guselkumab and tildrakizumab for the treatment of moderate to severe plaque psoriasis

<p><b>Objective:</b> To systematically analyze the efficacy and safety of interleukin (IL)-12/23, IL-17, and selective IL-23 inhibitors in moderate to severe plaque psoriasis.</p> <p><b>Methods and results:</b> Twenty-four randomized placebo-controlled trials were included. Compared to placebo, risk ratios (RR) of achieving PASI-75 and PGA/IGA 0/1 respectively were 20.20 (95% CI 13.82–29.54, <i>p</i> < .00001) and 14.55 (10.42–20.31, <i>p</i> < .00001) for ustekinumab 90 mg, 13.75 (8.49–22.28, <i>p</i> < .00001) and 9.81 (5.70–16.89, <i>p</i> < .00001) for ustekinumab 45 mg, 17.65 (12.38–25.17, <i>p</i> < .00001) and 26.13 (16.05–42.53, <i>p</i> < .00001) for secukinumab 300 mg, 15.36 (10.76–21.94, <i>p</i> < .00001) and 20.91 (12.82–34.13, <i>p</i> < .00001) for secukinumab 150 mg, 18.22 (10.63–31.23, <i>p</i> < .000001) and 18.82 (10.36–34.16, <i>p</i> < .00001) for ixekizumab 80 mg every 4 weeks, 19.83 (11.07–35.52, <i>p</i> < .00001) and 20.41 (11.01–37.81, <i>p</i> < .00001) for ixekizumab 80 mg every 2 weeks, 14.79 (9.86–22.16, <i>p</i> < .00001) and 21.93 (15.52–31.01, <i>p</i> < .00001) for brodalumab 210 mg, 11.55 (7.77–17.18, <i>p</i> < .00001) and 16.59 (11.72–23.49, <i>p</i> < .00001) for brodalumab 140 mg, 12.40 (8.87–17.34, <i>p</i> < .00001) and 10.84 (7.91–14.85, <i>p</i> < .00001) for guselkumab 100 mg, 11.45 (7.45–17.58, <i>p</i> < .00001) and 10.97 (6.44–18.69, <i>p</i> < .00001) for tildrakizumab 200 mg, 11.02 (7.17–16.93, <i>p</i> < .00001) and 10.03 (6.45–15.59, <i>p</i> < .00001) for tildrakizumab 100 mg. Similar outcomes were seen for PASI-90. Safety was satisfactory for each therapy at any dose, but a slightly increased risk of withdrawal due to toxicity was observed in individuals receiving ixekizumab compared to placebo.</p> <p><b>Conclusion:</b> Ustekinumab, secukinumab, ixekizumab, brodalumab, guselkumab, and tildrakizumab were highly efficacious and generally well-tolerated when used as treatments for moderate to severe plaque psoriasis.</p

Low PSA radiographic disease progression on C11‐choline PET

Abstract Background For men with prostate cancer, radiographic progression may occur without a concordant rise in prostate‐specific antigen (PSA). Our study aimed to assess the prevalence of radiographic progression using C‐11 choline positron emission tomography (PET) imaging in patients achieving ultra‐low PSA values and to evaluate clinical outcomes in this patient population. Methods In a single institution study, we reviewed the prospectively maintained Mayo Clinic C‐11 Choline PET metastatic prostate cancer registry to identify patients experiencing radiographic disease progression (rDP) on C‐11 choline PET scan while the PSA value was less than 0.5 ng/mL. Disease progression was confirmed by tissue biopsy or response to subsequent therapy. Clinicopathologic variables were abstracted by trained research personnel. Overall survival was estimated using the Kaplan–Meier method. Intergroup differences were assessed using the log‐rank test. A univariate and multivariate Cox regression model was performed to investigate variables associated with poor survival after rDP. Results A total of 1323 patients within the registry experienced rDP between 2011 and 2021, including 220 (16.6%) men with rDP occurring at low PSA level. A median (interquartile range [IQR]) of 54.7 (19.7–106.9) months elapsed between the time of prostate cancer diagnosis and low PSA rDP, during which 173 patients (78%) developed castration‐resistant prostate cancer (CRPC). Sites of low PSA rDP included local recurrence (n = 17, 8%), lymph node (n = 90, 41%), bone (n = 94, 43%) and visceral metastases (n = 19, 9%). Biopsy at the time of rDP demonstrated small‐cell or neuroendocrine features in 21% of patients with available tissue. Over a median (IQR) follow‐up of 49.4 (21.3–95.1) months from the time of low PSA rDP, 46% (n = 102) of patients died. Factors associated with poorer survival outcomes include advanced age at rDP, CRPC status, bone and visceral metastasis (p value <0.05). Visceral metastases were associated with decreased overall survival (p = 0.009 by log‐rank) as compared with other sites of rDP. Conclusions Men with prostate cancer commonly experience metastatic progression at very low or even undetectable PSA levels. Periodic imaging, even at low absolute PSA values, may result in more timely identification of disease progression

The Transplant Index (TI): a novel method to predict adult liver transplant waitlist outcomes

BACKGROUND: The field of transplantation is shifting outcome priorities from 1-year survival to more comprehensive metrics including transplant rate and waitlist mortality. Identifying disenfranchised candidates (high waitlist death risk, low transplantation chance) can be a focus to improve outcomes. METHODS: Given waitlist outcomes, (continued waiting, death, and transplantation), we aimed to identify factors predicting the likelihood candidates would undergo transplant or death by performing multivariate competing risk analyses of 121 198 candidates in the United Network for Organ Sharing database. We incorporated these probabilities (likelihood of transplantation and waitlist death) into the transplant index (TI) to identify disenfranchised candidates (high likelihood of death, low likelihood of transplantation). RESULTS: Half of the patients had low incidences of death and transplantation within 90 days (TI-inactive). The remaining were stratified into 10 groups within a predictive index, the TI. Low-TI groups (TI-10, 20, 30) had 90-day transplant rates of 50.8%, 41.6%, and 39.8% respectively, and their respective 90-day death rates were 22.8%, 15.1%, and 10.9%. High-TI groups (TI 80, 90, >90) had 90-day transplantation rates of 53.7%, 64.3%, and 73.9% respectively, and 90-day death rates of 5.9%, 6.5%, and 6.7% respectively. As TI increased, the likelihood of transplantation increased and that of death decreased. Low-TI groups represent the disenfranchised candidates. CONCLUSIONS: The TI identifies disenfranchised candidates on the adult liver transplant waitlist. This is the subgroup that would benefit the most from efforts to increase access to transplantation

Role of vitamin K2 in preventing the recurrence of hepatocellular carcinoma after curative treatment: A meta-analysis of randomized controlled trials

<p>Abstract</p> <p>Background</p> <p>Hepatocellular cancer is notorious for recurrence even after curative therapy. High recurrence determines the long term prognosis of the patients. Vitamin K2 has been tested in trials for its effect on prevention of recurrence and improving survival. The results are inconclusive from individual trials and in our knowledge no systematic review which entirely focuses on Vitamin K2 as a chemo preventive agent is available to date. This review is an attempt to pool all the existing trials together and update the existing knowledge on the topic.</p> <p>Methods</p> <p>Medline, Embase and Cochrane Register of Controlled trials were searched for randomized controlled trials where vitamin K2 or its analogues, in any dosage were compared to placebo or No vitamin K2, for participants of any age or sex. Reference lists and abstracts of conference proceedings were searched by hand. Additional papers were identified by a manual search of the references from the key articles. Attempt was made to contact the authors of primary studies for missing data and with the experts in the field.</p> <p>Trials were assessed for inclusion by two independent reviewers. Primary outcomes were recurrence rates and survival rates. There were no secondary outcomes. Data was synthesized using a random effects model and results presented as relative risk with 95% Confidence Intervals.</p> <p>Result</p> <p>For recurrence of hepatocellular cancer after hepatic resection or local ablative therapy, compared with controls, participants receiving Vitamin K2, pooled relative risks for hepatocellular cancer were 0.60; 95% CI: 0.28–1.28, p = 0.64) at 1 yr 0.66; 95% CI: 0.47–0.91), p = 0.01) at 2 yr; 0.71; 95% CI: 0.58–0.85, p = 0.004) at 3 yr respectively. The results were combined using the random analysis model.</p> <p>Conclusion</p> <p>Five RCTs evaluated the preventive efficacy of menatetrenone on HCC recurrence after hepatic resection or local ablative therapy. The meta-analysis of all five studies, failed to confirm significantly better tumor recurrence- free survival at 1 year. Improved tumor recurrence at 2nd and 3rd year may be just due to insufficient data. There was no beneficial effect on the overall survival. However, to confirm the beneficial effect or lack of it, large, higher quality randomized controlled trials are still required.</p